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Acting on Concerns – What can we learn from the story of Kitty Genovese?

In the early hours of March 13th 1964, Kitty Genovese was brutally murdered just yards from her home in New York. It was reported that 38 neighbours witnessed the attack, but none raised the alarm or came to Kitty’s aid as she lay dying in a stairwell.

It turned out that in fact one neighbour had yelled out and Kitty’s attacker ran off. After a short while however, he returned to finish the job. By the time a second neighbour called emergency services, Kitty was dead.

Both the press and public were deeply disturbed by the apparent inaction of Kitty’s neighbours. Commentators viewed it as emblematic of a callous and careless attitude that permeated modern cities. This was the version of events that passed into history. More usefully, the story of Kitty’s death also inspired seminal research into how people behave when things go wrong around them.

This year, the NHS has faced press and public outrage about failures to respond when things have gone wrong. In March we heard how some staff at Mid Staffordshire hospital tried to raise concerns about what was happening to patients, but leaders carried on as though everything was fine. In November we were hearing that senior managers at Colchester hospital had dismissed as fantasy reports that patient records were being falsified.

So what can research tell us about why apparently well-intentioned people fail to act in situations that appear – with the benefit of hindsight – to have been crying out for a response?

Kitty’s murder prompted social psychologists Darley and Latané to begin a series of experiments to understand how people react in situations where others need their help. Their research into pro-social behaviour significantly informed Georgetown University Professor Maria Miceli and her colleagues, who have drawn on it to understand organisational “whistleblowing”.

Understanding what stops people speaking up is important. But just as important is understanding what stops others acting, when concerns are raised. We believe that the same factors that make it hard to speak up can also make it difficult to act upon what people are telling you.

Research suggests that there are five key obstacles to overcome.

First, someone needs to notice that something is actually wrong. This means not just seeing but believing.

Hindsight enables us to be both baffled and angry when we hear about apparently obvious neglect or wrongdoing that goes unchallenged. In the heat of the moment though, witnesses are vulnerable to a number of inhibiting perception biases.

One of these is “normalising”. When incoming information conflicts with our preferred version of reality, we have to make sense of it. We can tell ourselves that what we read or heard or saw has a reasonable explanation, and that all systems are normal. Or, we can adjust our version of reality. This means that things are now not normal and we have a problem needing to be solved.

In a pressured work environment where people are already overwhelmed with insoluble problems, the unconscious temptation to normalise is obvious. This tendency to assimilate disturbing information into a picture of “reasonable normality” is why – as one medical director explained in recent research – clinical governance committees can sometimes end up assiduously rubber-stamping poor care outcomes.

The second obstacle is the “bystander effect” identified in Darley and Latané’s early research. They found that contrary to common expectations, the larger the numbers of witnesses to an event the less likely it is that someone will step forward to intervene. The diffusion of responsibility amongst onlookers creates a feeling of uncertainty about taking action. In a healthcare context the result can be apparently inexplicable inaction in the face of manifestly undignified or unsafe care.

The third obstacle comes from how the organisation signals what matters to it, and hence what it will do with unpleasant messages. Organisational stories are what really influence behaviour, and are of at least equal importance to official policies. Imagine a healthcare organisation awash with stories of staff being meaningfully rewarded for acting on concerns. We would expect it to elicit more pro-social behaviour than its neighbour, where all the stories are about how management shoots its messengers.

A fourth obstacle is knowing that when you raise concerns you have a reasonable likelihood of success. The Francis Inquiry highlighted the often bruising and career-limiting experiences of those who do “whistle-blow”. But people who successfully raise concerns rarely shout about their actions and consequently, we may underestimate the likelihood of achieving a good result.

The final obstacle arises as people weigh up the pros and cons of taking action. So, what goes wrong at this stage? Individuals may be less inclined to report apparently minor harms, so low level wrongdoing often passes unhindered. Where evidence is ambiguous, reporting becomes difficult and no further inquiry – which could yield clearer evidence – is ever mounted. The decision may be affected by broadly “moral” calculations such as whether a wrongdoer was responsible for their action, or whether – perhaps – they were overwhelmed with work. And finally, there is a continuing reticence to report concerns relating to those with status and the power to retaliate.

People on the receiving end of escalated concerns face very similar challenges. They too must resist normalising and refuse to be bystanders. They too need support from colleagues when they “speak truth to power”. They have to believe that action can improve the situation, and have to make a reasonable moral assessment of the problem. Finally, they too must be prepared to call those in power to account

About

Murray Anderson-Wallace has a clinical background in mental health services and psychological therapy, but has spent most of his career specialising in the social psychology of organisation and applied communications research.

He works as an advisor to organisations, networks and campaigns, supporting them to tackle significant professional, ethical and social issues in more sensitive, humane and effective ways.

Murray is Visiting Professor at the Health Systems Innovation Lab at London South Bank University, where he co-leads the Darzi Clinical Leadership Programme.

His practice also includes work as an independent journalist and editor, producing media to stimulate debate about socio-cultural issues in complex human systems.